<%@page pageEncoding="UTF-8" contentType="text/html; charset=UTF-8" %>
<%@ taglib uri="http://java.sun.com/jsp/jstl/core" prefix="c" %>
<!doctype html>
<html>
<head>
    <%@include file="common/head.jspf"%>
    <script type="text/javascript" src="js/reg.js"></script>
    <title>会员登录</title>
</head>

<body id="user-reg">
    <nav class="navbar text-nav" role="navigation">
        <a class="pull-left btn-back" href="loginPage"><i class="icon-chevron-left"></i></a>
        <div class="center-block nav-title">会 员 注 册</div>
    </nav>
    <div class="reg-form">
        <form method="post" action="register">
            <div class="form-group">
                <label for="mobilephone">联系电话:</label>
                <input class="form-control" type="text" name="mobilephone" id="mobilephone" placeholder="请输入联系电话">
            </div>
            <div class="form-group">
                <label for="password">密&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;码:</label>
                <input class="form-control" type="password" name="password" id="password" placeholder="请输入密码" value="" class="ui-corner-all">
            </div>
            <div class="form-group">
                <label for="repassword">确认密码:</label>
                <input class="form-control" type="password" name="repassword" id="repassword" placeholder="请再次输入密码" value="" class="ui-corner-all ">
            </div>
            <div class="form-group">
                <label for="carno">车 牌 号:</label>
                <input class="form-control" type="text" name="carno" id="carno" placeholder="请输入车牌号" value="" class="ui-corner-all">
            </div>
            <div class="form-group">
                <label for="name">被保险人姓名:</label>
                <input class="form-control" type="text" name="name" id="name" placeholder="被保险人姓名" value="" class="ui-corner-all">
            </div>
            <div class="checkbox">
                <label style="font-size: 4vw">
                    <input type="checkbox" name="checkbox" checked="true">我已看过并同意<a href="#">《XXX服务协议》</a>
                </label>
            </div>
            <div class="form-group">
                <button class="btn btn-pa-large btn-block">立即注册</button>
            </div>
        </form>
    </div>
</div>
</body>

</html>
